Despite opting for flexible quarantine measures Sweden has been trailing far behind Spain, Italy and the UK in terms of confirmed COVID-19 cases and related deaths with just 23,216 infected and 2,854 fatalities. However, at the same time, the Nordic country has substantially outpaced its neighbours, Denmark, Norway and Finland which account for 503, 214 and 246 fatalities, respectively. Whether or not Stockholm's health strategy has worked will be seen in coming months, say Swedish observers.
Functioning Economy & Herd Immunity
"I think it will prove to be a good strategy in the long run", says Peter Nilsson, a professor of internal medicine and epidemiology at Lund University.
He notes that the Swedish "flexible restrictive strategy" allowed the country to keep the economy afloat and avoid a spike in unemployment rates.
"It's so important to understand that the deaths of COVID-19 will be far less than the deaths caused by societal lockdown when the economy is ruined. Why? Because of unemployment and all the social problems with it. A bad economy will hurt and kill people in the future", the academic argues.
In addition, one of the consequences of the strategy is herd immunity, Nilsson stresses, adding that the second and, possibly, the third wave of COVID-19 will become the litmus test for the approaches adopted by Sweden and other countries.
"Sweden could reach heard immunity earlier than other countries which means that the spread of the virus and the number of deaths will decrease since a majority of the population will be immune", echoes Mikael Rostila, professor at the Department of Public Health Sciences at the Stockholm University. "Other countries that start to reopen now may experience a second wave of the virus. So it might be that they have just postponed a severe outbreak".
The idea of herd immunity has been repeatedly voiced by Anders Tegnell, epidemiologist with the Swedish Public Health Agency and the country's COVID strategy architect. However, the World Health Organisation (WHO) warned in an April statement that there is "no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection".
Failures of Swedish Strategy: Elderly & Ethnic Minorities
Nevertheless, Swedish academics admit that the country's death toll is higher than that in neighbouring Nordic states. What's worse, the pandemic has found its way to the homes for elderly, they note.
"We must do much more testing", Peter Nilsson says. "We must offer much better equipment. And of course, it's a matter of education. It has been said in Stockholm, for example, that many of the staff in the home for the elderly, they are just temporarily employed. They come work for some hours, then go home. And young people like students do some extra work. Of course, many of them perhaps are not as well educated as the regular staff. So also, our officials have declared that this is something tragic, that we hope that other countries can protect the elderly in a better way".
A very large number of deaths in care homes has triggered a lot of criticism towards the strategy, points out Paul Franks, a professor in genetic epidemiology at Lund University.
The other problem is that Sweden has failed to shield its vulnerable ethnic minorities from the pandemic, he says.
"You know, about 10% to 15% of the population are made up of immigrants", he says. "Many of them don't speak Swedish or English. And so communication was not great. And accordingly, unfortunately, many of the early deaths came amongst immigrant communities".
In April the Swedish Public Health Agency underscored that the country's large immigrant groups had a higher risk of being hit by COVID-19 than compared to ethnical Swedes. "Among the Somalis the risk is almost five times higher than compared to people born in Sweden," admitted Swedish state epidemiologist Anders Tegnell on 14 April as cited by EuroObserver.
'We Have to Wait & See How It Will Play Out'
In mid-April a group of 22 scientists from top Swedish universities and research institutes wrote an open letter in the Dagens Nyheter criticising the Public Health Agency for its 'deeply flawed' approach and urged the government to revise the strategy as Sweden's COVID death toll reached 1,000 people.
"Of course, they are very, very worried about deaths, about prediction of even more deaths", comments Peter Nilsson. "But our best experts predict between 10,000 and 20,000 deaths. 80% or 90% will be elderly. Just a few will be younger people. And some of these experts do not take into account what we discussed - the second wave and the financial crisis that would kill even more people".
There is a mix of factors that point to success and some that point to a failure, but that is a fair price, according to Paul Franks.
"Let's say on face value, you can say - the strategy in Sweden hasn't worked because we had many more deaths than any other countries", he says. "However, to maintain a lockdown, you know, until a vaccine is available - people generally accept that it is unrealistic. So, most countries are trying to reopen their societies. Sweden does not have to reopen its society now. It has to maintain what it's been doing already. Which is possible. It could be done".
Despite mounting criticism from many countries the world "now seems more positive to the Swedish strategy since there is a big pressure to reopen societies", observes Mikael Rostila.
He refutes the idea that the Swedish model can be adopted by any country: "Swedes have high trust in the state institutions and politicians which has been shown in many surveys", the professor says. "Therefore Sweden can have a different strategy which is based on belief that citizens will follow the advice given by the government and public health agency without bans or laws".
"It remains to be seen if the Swedish strategy is the most successful", Rostila stresses.
"Looking back, after one or two years, we can evaluate this", agrees Peter Nilsson. "So it's very important to understand that even if developers are different in different countries. So it cannot be evaluated fully correctly when we are just in the middle of it. We have to wait and see".